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Background Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor. Objective To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function. Methods Patients with first diagnosis of significant AS were selected and stratified according to history of AF. The endpoint was all-cause mortality. Results In total, 2849 patients with significant AS (mean age 72 ± 12 years, 54.8% men) were evaluated, and 686 (24.1%) had a history of AF. During a median follow-up of 60 (30–97) months, 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared to 36.8% in patients with sinus rhythm (SR) (log-rank P Conclusion Patients with significant AS and AF have a reduced survival as compared to patients with SR. Nonetheless, when correcting for markers of LV diastolic function, AF was not independently associated with outcomes in patients with significant AS.

BACKGROUND The prognostic implications of discordant grading in severe aortic stenosis (AS) are well known. However, the prevalence of different flow-gradient patterns and their prognostic implications in moderate AS are unknown.OBJECTIVES The purpose of this study was to investigate the occurrence and prognostic implications of different flow-gradient patterns in patients with moderate AS.METHODS Patients with moderate AS (aortic valve area >1.0 and = 20 mm Hg) and discordant moderate AS including 3 subgroups: normal-flow, lowgradient moderate AS (MG = 35 mL/m(2), and LVEF >= 50%); "paradoxical" low-flow, low-gradient moderate AS (MG < 20 mm Hg, SVi = 50%) and "classical" low-flow, low-gradient moderate AS (MG

Background: Recent data showed poor long-term survival in patients with moderate AS. Although sex differences in left ventricular (LV) remodeling and outcome are well described in severe AS, it has not been evaluated in moderate AS. Methods: In this retrospective, multicenter study, patients with a first diagnosis of moderate AS diagnosed between 2001 and 2019 were identified. Clinical and echocardiographic parameters were recorded at baseline and compared between men and women. Patients were followed up for the primary endpoint of all-cause mortality with censoring at the time of aortic valve replacement. Results: A total of 1895 patients with moderate AS (age 73 +/- 10 years, 52% male) were included. Women showed more concentric hypertrophy and had more pronounced LV diastolic dysfunction than men. During a median follow-up of 34 (13-60) months, 682 (36%) deaths occurred. Men showed significantly higher mortality rates at 3 -and 5-year follow-up (30% and 48%, respectively) than women (26% and 39%, respectively) (p = 0.011). On multivariable analysis, male sex remained independently associated with mortality (hazard ratio 1.209; 95% CI: 1.024-1.428; p = 0.025). LV remodeling (according to LV mass index) was associated with worse outcomes (hazard ratio 1.003; CI: 1.001-1.005; p = 0.006), but no association was observed between the interaction of LV mass index and sex with outcomes. Conclusions: LV remodeling patterns are different between men and women having moderate AS. Male sex is associated with worse outcomes in patients with medically treated moderate AS. Further studies investigating the management of moderate AS in a sex-specific manner are needed.

Aims Moderate aortic stenosis (AS) is associated with an increased risk of adverse events. Because outcomes in patients with AS are ultimately driven by the condition of the left ventricle (LV) and not by the valve, assessment of LV remodelling seems important for risk stratification. This study evaluated the association between different LV remodelling patterns and outcomes in patients with moderate AS. Methods and results Patients with moderate AS (aortic valve area 1.0–1.5 cm2) were identified and stratified into four groups according to the LV remodelling pattern: normal geometry (NG), concentric remodelling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR). Of 1931 patients with moderate AS (age 73 ± 10 years, 52% men), 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH, and 420 (22%) EH. Patients with CH and EH showed higher 3-year mortality rates (28% and 32%, respectively) when compared with patients with NG (19%) (P < 0.001). After multivariable adjustment, CH remained independently associated with mortality (HR 1.258, 95% CI 1.016–1.558; P = 0.035), whereas both CH (HR 1.291, 95% CI 1.088–1.532; P = 0.003) and EH (HR 1.217, 95% CI 1.008–1.470; P = 0.042) were associated with the composite endpoint of death or AVR. Conclusion In patients with moderate AS, those who develop CH already have an increased risk of all-cause mortality. Assessment of the LV remodelling patterns may identify patients at higher risk of adverse events, warranting closer surveillance, and possibly earlier intervention.

Aims The aim of this study is to investigate the independent determinants of survival in patients with moderate aortic stenosis (AS), stratified by severity of symptoms and left ventricular ejection fraction (LVEF). Methods and results Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.5 cm2) were identified. Patients were stratified by New York Heart Association (NYHA) functional class (NYHA I, NYHA II, or NYHA III–IV) and LVEF (LVEF ≥60%, LVEF 50–59%, or LVEF Conclusion Moderate AS is associated with poor long-term survival. Baseline symptom severity and LVEF are associated with worse outcomes in these patients. Patients with low-normal LVEF (

Sex-related differences are a field of interest in heart failure (HF) and valvular heart disease. This study sought to assess the sex-related differences in patients with moderate aortic stenosis (AS). Patients with aortic valve area >1.0 cm2 and ≤1.5 cm2 were selected. Clinical and

Introduction Aortic dissection limited to the abdominal aorta is not common. This case report describes the role of duplex ultrasound in the diagnosis of asymptomatic dissection of the abdominal aorta. Case Report A 59-year-old man with hypertension and mild renal impairment was referred to the vascular laboratory for color ultrasound examination of the renal arteries to rule out renal arterial stenosis. The ultrasound examination revealed a nonsignificant (Conclusion Color duplex ultrasound may be operator dependent but it is a highly sensitive and cost effective modality for identifying abdominal aortic dissection.

Left ventricular diastolic filling was characterized by transmitral pulsed-wave Doppler velocities in 62 patients with acute myocardial infarction, and diastolic filling variables were correlated with the presence of clinical heart failure. At the time of admission, 47 patients were free of heart failure and 15 patients were in Killip class II to IV. In the latter group of patients with heart failure, peak velocity of late filling wave caused by atrial contraction (A) was lower (0.48 versus 0.59 m/sec, p0.05), ratio of peak velocity of early rapid filling wave to peak velocity of late filling wave caused by atrial contraction (E/A) was higher (1.5 versus 1.1, p0.01), and deceleration time (136 versus 196 msec, p = 0.0001) was shorter when compared with the patients not in heart failure after acute myocardial infarction. Multivariate analysis showed that the deceleration time was a powerful independent predictor of presence of heart failure after controlling for systolic functional variables. Therefore, diastolic filling variables can complement systolic functional variables in the identification of the patients with postinfarction left ventricular failure.

In 25 patients with acute myocardial infarction and in 25 normal subjects, pulsed-wave Doppler echocardiography was performed in the apical four-chamber view with the sample volume first between the mitral leaflet tips and then at the mitral anulus. The early filing wave (E) and late filling wave (A) peak velocities measured from Doppler strip charts were significantly (p less than 0.001) higher at the tips in both groups. E velocity increase was greater than A velocity increase, producing a significantly (p less than 0.001) higher E/A velocity ratio at the tips than at the anulus. The deceleration time was longer at the tips than at the anulus (p less than 0.001) in both groups. Therefore it is important to know sample volume location in the interpretation of mitral inflow velocity. It is critical to maintain the same sample volume location in serial assessments of left ventricular diastolic filling characteristics.